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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 9/14/2016Sep 2516 09:25p Ellmann Service Cc 9702233324 p.6 0, r Planning, ©evelopinent & Transportdtn al to283. N. College Ave . - P.O. Box 580 ? Flirt hind Fort Collins, CO 80524 Phone 970-416-2740 Fax 22461'�4 OVER-THE-OOUNTIER PERNTS 'ONLY .. t This application Is to be used to apply for the fc1lawing permits only (check all that apply), 0 Air conditioning CI Demolition (Interior non-stfuebual) Ci Eilectrical Aiterafion (not service change) 0 Gas Vghter Q Ges Log .. D Heating Unit Q Lawn Sprinkler Q.Mobile Home replacement ❑ Roafing 0 Sewer Una -13 Photo voltaic CI-Ventilml ater Heater Q Water Urine 0 WaodlPeilet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications ill not be accepted. Application # E21 � 0 IJ Date 1 f Si Faro 7hr me only Sob Ste Adds (rv.Wiw) Value of Construction (labor, materials, profit) 2 uk . S R1112=ai m Address l 3ty!D 3. City/State !>-nVer' lip Pllone7 0 o n War o `T31y ! t7 - 222. - - . -' 'f?0 Applicant Name Address City/State. Tip Phone �j�E�fS'br� S V fv �`ia�..r•% cif %fs � .4i�-S{./'�'�+ � 1 J i yy ��rj-:�s1�.�.7T� ?•� Contracor lrc # Address CityrlState Zip Phone l J�ii:-.'!/iL+f �?r�. yiC••L f- �� J`i1 f � �r�it�7r-'2 5�n'•T�2 Si�'Ift ��h7r� Contractor City of Ft Collins Sales Tax -9 3-R-,2of- - Are you paying taxes here or by reports Q Here IXRVort SalestaxaamberIsr071*WAY. all CM&I tcr: Are you paying with your trust account? WYes 0 No f Is this a residentfal or commerdal pMpsct7 WResddaffal ElComnwdal If residential, is it: 0SIngfe Family Detached 13Condoltownhome (single family attached) Cl Dupfex 0 Multifamily (aparlment)© Garage _iram iercial, is it: 0' Bank © Bar 0 Church ❑ Hotel/Motel 13 Medical office fl Office 13 ReW .. 13 Restaurant 0 other (explain) Is this building 5o years of age or more? ayes c No .rfyg* Jgvfngynco tip CM&CttlwsorlcAwssarmcw If this is for 6 dermoliUon permit; what year. was the building constructed? Ifprior tD -W75, )09 wN need an advAnassessmerrt to submit ryM bW appllce om Description of *If lawn sprinlderibaddlow preventer, must list licensed phimber. If first-time A/c; must list licensed electdcfan. -5ubeontr8C10rs: ListdiecompanyrfamearGlyafRG'oNrrtrGcenseT ir Eleelsidart ply. i - Nlechanicai Roofer Other —�. . I hereby acknowledge thatl have read this application and stale that the above information i5 completae and Correct: I agree fn Comply with aR requirements contained herein and d-ty ordinances and state laws regulating building construction. t know that a permit Is not trend until it has beeF1 paid and Issued. Applicant: _ .. .,.,,_ j► �//r f/ print Nam. ;r— -- e �g9 Date